1. VERTEBRAL FRACTURES-AN UNCOMMON COMPLICATION FOLLOWING FIRST EPISODE
OF A CONVULSIVE SEIZURE
PRESENTING AUTHOR :
DR.NALLI .R .GOPINATH
JUNIOR CONSULTANT
DR.MEHTA’S HOSPITAL, CHENNAI-34
TAMIL NADU,INDIA
ABSTRACT NO : 35846
PROF.DR.NALLI .R .UVARAJ’s UNIT
DR.MEHTA’S HOSPITAL, CHENNAI-34
TAMIL NADU,INDIA

2. .PATIENT ADMITTED WITH C/O -
PRESENTING HISTORY
Mr. S – 18 YRS /M
.PATIENT ADMITTED WITH C/O -
: FEVER WITH CHILLS AND RIGOR – DAYS
: EPIGASTRIC PAIN &VOMITING OF BLOOD DAYS
: LOSS OF APPETITE
H/O PRESENTING ILLNESS-
DEVELOPED AN EPISODE OF SEIZURE FOR THE FIRST TIME ON THE NIGHT AFTER ADMISSION TO THE HOSPITAL WHEN HE WAS SITTING IN BED. PATIENT HAD NO FALL. NEXT DAY HE COMPLAINED OF PAIN IN THE CHEST AND BACK
PAST HISTORY – NO SIGNIFICANT TRAUMA
NO H/O TUBERCULOSIS
NOT A KNOWN EPILEPTIC

3. CLINICAL FINDINGS G/E: MODERATELY BUILT
NOT ANAEMIC/ICTERIC/NO PEDAL EDEMA/
NO CYANOSIS/CLUBBING/NO LYMPHADENOPATHY
NO MASS PER ABDOMEN
EXAMINATION OF THE SPINE:
NO SPINAL DEFORMITIES.
TENDERNESS OVER THE SPINE – MID DORSAL REGION
MOVEMENTS WERE NORMAL
NO NEUROLOGICAL DEFICIT.
INVESTIGATIONS
Mantoux , ESR, CRP - NORMAL
Sr.Ca,P ,SALP = NORMAL

5. D4

6. HOW WE MANAGED? FOLLOW UP. ADVISED COMPLETE BED REST, ANALGESICS,
STARTED ON ANTI EPILEPTIC DRUGS.
FOLLOW UP.
Pain at fracture site persisted for 2 weeks.
Antiepileptic drugs continued for 6 months.
No further seizures reported.

7. 2 YRS FOLLOW UP.....

8. DISCUSSION
SEIZURES AND FRACTURE
Vertebral compression fractures are well known complications of convulsive tonic clonic seizures(mostly unwitnessed)Matson et al.2004
DUE TO FALL /ACCIDENT – 1 TO 16%
-Pederson et al 1976,Youssef et al 1995
DUE TO PARASPINAL MUSCLE SPASM ALONE – 0.3%
-Finelli et al 1989,Vernay et al 1990
Vertebral compression fractures are well known complications
of convulsive seizures(mostly unwitnessed)
15% ARE ASYMPTOMATIC
Most frequent during nocturnal attacks&
In known status epilepticus
M:F ratio 3:1 , adults> children
MC in mid-thoracic spine (T3-T8)
Lumbar vertebral involvement rare

9. THE CAUSE?
Strong muscular contractions during a “fit” can collapse the vertebrae
- Lehndorff,1907
Violent muscular contractions of the posterior spinous and abdominal muscles flexes the spine forward and subjects it to axial loading and flexion compression forces.
COMPRESSION FRACTURES-TYPICAL
BURST FRACTURES-OCCASIONAL
Nocturnal vertebral compression fractures may be the presenting feature of unwitnessed convulsive seizures
Evaluation for epilepsy should be considered in what may appear to be an idiopathic vertebral compression fracture.
Nocturnal vertebral compression fracture-A presenting feature of unrecognized epileptic seizure .,Amer G, Aboukasm,MD ,Brian J. Smith, MD ARCH FAM MED/VOL 6,MARCH/APR 1997

10. CONCLUSION
Seizure-induced injuries can appear clinically asymptomatic and can easily be overseen due to absence of trauma and post-ictal amnesia.
CRITICAL EXAMINATION OF PATIENTS WITH SEIZURES FOR FRACTURES ESPECIALLY OF THE SPINE OR LIMBS IS ESSENTIAL
Epilepticky zachvat s nasledkem fraktury bederni patere= A.T MEHLHORN.PC STROHM.O.HAUSSCHILDT et al